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In patients with chronic renal failure be they hemodialysed or transplanted, viral hepatitis B and C tend to progress towards chronicity, in spite of both a frequent silent clinical presentation and an atypical course of viral markers. Therefore, only liver biopsy will allow a precise diagnosis of liver disease in these patients. Immunosuppression clearly modifies natural history of B and C viral hepatitis, but their real impact at mid and long-term on patient survival is still a matter of debate. Treatment is firstly preventive (vaccination and isolation of infected patients in dialysis units) and secondly curative. Preliminary data suggest that antiviral drugs such as ARA-AMP and interferon-alpha may have the same efficacy as in non-immunosuppressed patients. It is therefore of urgent need to evaluate both efficacy and tolerance of these antiviral drugs in patients on hemodialysis and in kidney transplant recipients.